USA health care: broken, or in need of emancipation from “bean counters”?

by ROB Tue Apr 24, 2012 12:58 am

ABC World News with Diane Sawyer

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By CHRISTOPHER TOKIN, M.D., ABC News Medical Unit
April 23, 2012

The vast difference in costs among hospitals for similar procedures was the focus of a new study by researchers at the University of California at San Francisco, whose findings were published Monday in the journal Archives of Internal Medicine. After reviewing charges from more than 19,000 patients, the researchers found that the cost for treatment of uncomplicated appendicitis, the same disease that [34-year-old San Francisco financial professional Augustin] Hong had, ranged from $1,529 to a whopping $182,955. To put this in perspective, the price of a new Maserati is $130,000.

“There is no standard in the United States for reasonable prices or reference pricing,” said lead study author Dr. Renee Hsia, associate professor of emergency medicine at the University of California at San Francisco, and a long-time friend of Hong's. “If you go to a hospital, they can charge you whatever they want. Negotiated rates are trade secrets,” she said.

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by ROB Tue Apr 24, 2012 1:11 am

U.S. health care and its health care deliverers are excellent. Control of U.S. health care needs to be wrested from the hands of accountants.

by Shirina Tue Apr 24, 2012 1:58 am

There needs to be a fixed price that everyone knows about beforehand. When I talked to my doctor about some minor out-patient surgery, he refused to give me a price upfront (even though I would have to pay out of pocket). How can I plan ahead or even know if I can afford it? When I pressed him for a price (surely he knows what he would charge), he would only say "several hundred dollars." How much is that? $200? $999? Big difference there.

Our health care system ranks 37th according to the WHO. Since our actual care is, indeed, excellet, our low rating comes almost totally from unequal access. We need NHS.

by ROB Tue Apr 24, 2012 2:20 am

There’s a procedure called colonoscopy, performed by an excellent MD known to me who specialized in that area. This MD argued with one of his patients’ health insurance provider about a prescribed medication. The insurance provider’s accountants didn’t want to pay for the medication because their medical advisor had advised then that it was unnecessary.

Who was this medical sage upon whose advice the bean counters denied prescribed medication to a patient/client whose monthly payment to the insurance company was around $600.00 per month? A retired dermatologist.

Your doctor may have had no choice but to be vague. Health care professionals control only the medical side of the coin; moreover, with retired dermatologists vetoing specialists’ medical decisions, they don’t even fuly control that.

by oftenwrong Tue Apr 24, 2012 10:11 am

The mistake was made by the Medical Profession in allowing the Insurance Companies to control so much of what should always have been clinical decision-making. The tail is wagging the dog in US medical care, and it's really up to the Clinicians to wrest control back from the Actuaries.

Are Insurers going to take their bat and ball home?

by ROB Tue Apr 24, 2012 3:30 pm

oftenwrong wrote:
The mistake was made by the Medical Profession in allowing the Insurance Companies to control so much of what should always have been clinical decision-making. The tail is wagging the dog in US medical care, and it's really up to the Clinicians to wrest control back from the Actuaries.

I’ve been told by folks who were “then and there” that Kaiser Permanente was the first comprehensive medical insurer. The Permanente medical group, owned then and now by doctors, MDs, DDSs, ODs, and the like, contracts with Kaiser, which owns the facilities and hires support staff, including PAs and RNs up through Nurse Practitioners, to provide Kaiser with some of the best physicians, dentists, eye doctors, etc., in their service areas.

When I joined Kaiser as an adult, my employer paid Kaiser premiums in full, leaving only a five dollar co-pay for all goods and services, from prescription medications through major surgery. One fellow I know paid a grand total of twelve dollars and fifty cents for open-heart triple bypass surgery. Two dollars and fifty cents of that was for the five daily newspapers he purchased during his recovery.

Most employers that contract with Kaiser Permanente, including public and private schools and social service agencies, no longer pay employee premiums. California, in which many Kaiser facilities are located, has been stripped of public funds by the Jarvis amendment (I believe it was Proposition 13), which in 1978(?) set a cap on property tax rates. During the current recession, single family housing prices in California have dropped at least fifty percent, and more than that in San Francisco. Prior to the most recent hit, the end of the Cold War back in 1991 caused whole communities to “dry up”, with laid off folks walking away from homes and mortgages they no longer could afford, putting a big hit on property tax revenues from which California hadn’t fully recovered in 2008.

At least the Permanente side of Kaiser Permanente still runs the show. No one second guesses physicians who’ve dedicated their lives to keeping people alive and healthy. The bean counters just count beans.

by oftenwrong Tue Apr 24, 2012 5:28 pm

Good to hear from someone who has been told by someone else what happened.

by **Ivan** Sat Aug 30, 2014 7:36 pm

A lady from the USA has posted on Twitter the bill for her caesarean section. Presumably this is the sort of thing that the Tories want for the people of the UK. Tough luck if you can't afford insurance:-

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by oftenwrong Sun Aug 31, 2014 10:22 am

"Stuffed their mouths with gold" Nye Bevan

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by stuart torr Fri Sep 05, 2014 11:15 am

Give the tories another term in office and our nhs system will disappear and become more like the USA HEALTH INSURANCE SERVICE.

by **Ivan** Sun May 28, 2017 5:58 pm

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by boatlady Mon May 29, 2017 6:51 pm

I've just read this on Facebook - horrifying

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USA health care: broken, or in need of emancipation from “bean counters”?

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